‘Untreatable’ cases of gonorrhea detected

A story published Monday by the British newspaper The Independent details worry in Australian and New Zealand doctors about the detection of a strain of gonorrhea resistant to the disease’s ‘last effective treatment option.’

The Associated Press

By Wes Wolfe / Staff Writer

Published: Monday, August 25, 2014 at 09:49 PM.

Gonorrhea is no longer the venereal disease acquired by sailors of dubious judgment and easily treated with penicillin.

After decades of treatments with numerous antibiotics here at home and worldwide, it — like other bacterial diseases — is evolving past treatments trusted to combat it. Monday, the British newspaper The Independent revealed a newly-resistant strain of gonorrhea was detected in a tourist from central Europe who picked it up in Sydney, Australia.

The paper quoted the president of the New Zealand Sexual Health Society, Dr. Edward Coughlan, who said of the discovery, “This is a major public health concern.”

In 2012, the World Health Organization warned governments of the necessity of stepped-up surveillance of gonorrhea, in that it could soon become untreatable. The same year, the Centers for Disease Control and Prevention launched guidelines designed to preserve what it called the last effective treatment option.

“While antibiotics have long been successfully used to treat gonorrhea, the bacteria has eventually grown resistant to every drug ever used to treat it, including sulfonamides, penicillin, tetracycline, and most recently fluoroquinolones,” according to the CDC guidelines, last published in July 2013. “In 2007, due to widespread drug resistance, CDC revised its gonorrhea treatment guidelines to no longer recommend fluoroquinolones.”

Dr. Solomon Shapiro, medical director at the Lenoir County Health Department, said he’s watched as the drugs, one after another, have been abandoned because of lack of effectiveness. What’s used here and worldwide is the injectable antibiotic ceftriaxone, combined with the oral antibiotic azithromycin.

Shapiro said the injected antibiotic is what effectively targets the gonorrhea infection, while the antibiotic taken orally is more to confuse the bacteria, so it doesn’t develop a resistance and subsequently spread.

Gonorrhea is no longer the venereal disease acquired by sailors of dubious judgment and easily treated with penicillin.

After decades of treatments with numerous antibiotics here at home and worldwide, it — like other bacterial diseases — is evolving past treatments trusted to combat it. Monday, the British newspaper The Independent revealed a newly-resistant strain of gonorrhea was detected in a tourist from central Europe who picked it up in Sydney, Australia.

The paper quoted the president of the New Zealand Sexual Health Society, Dr. Edward Coughlan, who said of the discovery, “This is a major public health concern.”

In 2012, the World Health Organization warned governments of the necessity of stepped-up surveillance of gonorrhea, in that it could soon become untreatable. The same year, the Centers for Disease Control and Prevention launched guidelines designed to preserve what it called the last effective treatment option.

“While antibiotics have long been successfully used to treat gonorrhea, the bacteria has eventually grown resistant to every drug ever used to treat it, including sulfonamides, penicillin, tetracycline, and most recently fluoroquinolones,” according to the CDC guidelines, last published in July 2013. “In 2007, due to widespread drug resistance, CDC revised its gonorrhea treatment guidelines to no longer recommend fluoroquinolones.”

Dr. Solomon Shapiro, medical director at the Lenoir County Health Department, said he’s watched as the drugs, one after another, have been abandoned because of lack of effectiveness. What’s used here and worldwide is the injectable antibiotic ceftriaxone, combined with the oral antibiotic azithromycin.

Shapiro said the injected antibiotic is what effectively targets the gonorrhea infection, while the antibiotic taken orally is more to confuse the bacteria, so it doesn’t develop a resistance and subsequently spread.

The problem is, that’s exactly what many experts believed happened when a Japanese sex worker tested positive for a gonorrheal strain resistant to ceftriaxone in 2009, and what’s subsequently been reported from Australia, along with reports from Norway, California and Hawaii the last few years.

In 2012, the CDC surveillance project on gonorrhea found a full third of samples tested were resistant to at least one or combinations of treatments used over the last several decades.

If in the event someone locally appeared to not benefit from normal treatment, calls would start going up the chain to see what needed to be done to treat the patient and to protect the public at large.

“I would call the local health department and say, ‘Hey — what’s up with this; have we seen this in our area,’ and really seek guidance from them,” said Kristen Hoover, infection preventionist at Lenoir Memorial Hospital. “And that’s just being really frank because the treatment guidelines that we follow are those that are issued by the North Carolina Division of Public Health and they review those every few years, or periodically, depending on what they are seeing to determine what drugs would work best, and make sure that we’re matching it.”

Hoover and Shapiro both said that it could be necessary to get scientists at the state level involved, and go from there.

Should a patient continually show up with the same gonorrhea symptoms and not put themselves in a situation in which they would be re-infected, “that would make me think something weird was going on here and would make sure this person is sent to the health department for further, more sophisticated testing,” Hoover said. “And, get guidance from the state communicable disease and STD folks to see what path would be best to take at that point.”

Wes Wolfe can be reached at 252-559-1075 and Wes.Wolfe@Kinston.com. Follow him on Twitter @WolfeReports.